Medical Examiner Dialogue: Vietnamese Buddhist

Introduction

Trust

Cross Cultural Mediator (CCM): Talking about trusting is very important. I work with Vietnamese patients in the hospital. If they trust you, they will tell you everything. If they don’t trust you, you will get nothing. Trust does not depend on how you are dressed. Whether you are wearing an official uniform or not, building trust will depend on how you deal with people, how you talk to them.

A Typical Death In The Vietnamese Community

CCM: When the old people are ill and know they are going to die, death is acceptable and is not shocking for the family. If a dying person is Buddhist and is in the hospital, he or she asks for the monk to come to the bedside to pray. The prayer may be said for the sick person to get better. If a person is expecting to die, people in the community want him or her to die peacefully.

Old people that are ill are usually not afraid of dying, but this may depend on the condition or illness. Sometimes, the illness prolongs a life too long, and the family will be hurt by spending a lot of money and time on prolonging life, even if the patient will not get better. Sometimes, because of the love and relationship between the family and the patient, the family tries to keep the dying person alive as long as possible without care about the cost. Some families are willing to pay for whatever is necessary. A terminally ill person who is expected to die usually prefers to die at home, with family members around them and with those they are close to at that time, rather than at the hospital.

Monk: Buddhism is the second largest religion in the world. Twenty percent of the world’s population is Buddhist. There are different kinds of Buddhism, however all Buddhists do meditation. One of the meditations done is on death. Everyday, through meditation, we recall our death and so we do not worry about dying. When a Buddhist person is dying, the family may think, “What can we do for the dying person?” They will invite a monk to see the dying person and to do chanting.

In Buddhism, the word chanting is used instead of prayer. As a person is dying we chant in permanency of the life. We do this for two reasons. First, we want to make the person happy before they die. Second, we want to make the family understand that death is a part of our life. It is because of our birth that we have to accept our death. Death is not unusual. That is the Buddhist point of view. So, everyday, when we finish our normal regular prayer, we do some meditation on death. That is why the Buddhist is not afraid to die, and also why the family is ready to accept the death.

Another point about death that is especially true in the Vietnamese community is that when someone dies, the family doesn’t call upon emergency officials right away. First, they try to bring the monk to the scene. If the monk is not available, they try to bring some elderly people who can chant Vietnamese chanting. The prayer is done first, and then the officials are called. In the case of death, it is very important to contact the family and ask them what they want to do before the officials come.

Some people believe that within the body the brain may die but the heart is still working a little bit. This makes the last minutes of life a very important time for the person to settle down, to make ready for rebirth. Buddhists believe in rebirth, not reincarnation. The death is just one thing that occurs for a person to be reborn somewhere else. The parents need to help the person to be reborn in the proper place by providing a peaceful and religious environment for death.

Suicide

Monk: As for death by suicide, the first important thing to know is that Buddhists do not agree with the act. Suicide goes against Buddhism. Many people use the term “vows” for what we call “precepts” in Buddhism. The first precept is to refrain from killing. As suicide is the act of killing yourself, it is considered bad. Practically and socially, if someone commits suicide, the Buddhist society does not value that death.

Buddhists condemn the action while still doing what they can for that person. They do not praise the action, but still do all the traditional prayers for the dead body. On uneral occasions for a suicide death, as a monk, I criticize the action and advise to those present that this is not the answer to a problem nor is it a brave action. This is the Buddhist point of view. Suicide is a very bad, lower choice. This belief is common in every Buddhist society and for the Vietnamese too.

CCM: The Vietnamese Buddhist is the same way. They
are against the action of suicide, but they do everything they can for
the traditional ceremonies and to help the family go through a difficult
period, perhaps even offering more support.

Medical Examiner: What if someone’s son committed
suicide and the family is opposed to even thinking that the death could
be a suicide? All evidence says that it is a suicide. As professionals,
we can write it down, or label it, as a suicide. The family may resist
this and may have great hostility toward us for labeling the death a
suicide. What can we do to work between the two different views? How
would we bring our views together?

CCM: That is really difficult. What happens with a suicide is really difficult and rough for the family. Try to work with the family. The family thinks that their son or daughter, whom they know, would never do something like that. It is very hard for them to accept. Just work with the family. Maybe after they go through the tough time and examine the situation again, then they will accept it. But it is very difficult.

Medical Examiner: Fortunately, a lot of time is one
of the things we have. We can be very gradual and slow about coming to
the conclusion of suicide. There is no real need to rush it. Some people
like an answer real fast, other people may want to have it very slow. I
guess what you are saying is, when working with the family, to give it
time.

Steps For The Medical Examiner To Take When Encountering A Death Of A Vietnamese Person

Getting Information from Family Members Effectively and Respectfully

Monk: Follow the same procedure as we would for any
other death. Inform the family. Tell them about the death, and ask them
if there is any religious thing they would like to do.

CCM: When a person dies, you inform the immediate family. Inform the parents first, or if they are not available, then tell the grandparents. If it is an elder or the parents that pass away, you tell the eldest son in the family. For Vietnamese, and I think for most of the Orientals, the eldest son has power and can make the family decisions. He can take over when the parents are not available or if for some reason the parents don’t want to deal with the situation. If it is necessary for investigators to disrobe the body in order to examine and take pictures of the body, and the family is at the scene, respectfully explain why you must do that, and they will understand.

Monk: You can follow your rules and regulations. We have no objection to that.

CCM: Talk to the eldest son. Speak first with the
father, and speak next with the eldest son or brother. Polite forms of
address and ways to show respect for the family and community include
bowing to show respect to the elders. Nowadays, shaking hands is common
with lots of people. If the medical examiner needs to go to someone’s
home, he may want to remove his shoes. Lots of families prefer that
practice even though we are here in the U.S. It will depend on the
family.

Getting Assistance From Religious And Spiritual Advisors

CCM: I think it is appropriate for the Medical
Examiners to approach the Monks in the temple if they need assistance
going to the family. The Medical Examiners should inform the monks in
advance of coming to the temple.

Medical Examiner: A young man passed away last week.
His folks were in Tibet and, through a lama, we got in touch with them.
The lama was given permission to handle things on behalf of the family.
The lama chose a monk who came to the hospital with another gentlemen
who spoke English pretty well, and things were taken care of. The
community and Medical Examiner took charge of a disposition for
cremation. The family didn’t want the body touched for three days. Is
that normal, to give the lama the authority to act on behalf of the
family, as far as disposition?

Monk: In a case like that, yes. The community is
allowed to go ahead in the family’s behalf. If you need support for
anything Buddhist, contact the Spiritual Care Department. That
department has a directory of temples.

Facilitator: It looks like strengthening the
connection between the Medical Examiner’s office and the Spiritual Care
Department would be useful. Also useful would be relying on the
Interpreter Services Department for the appropriate interpreter.

Autopsy

CCM: The time of death is a tough period for
everyone. It is important to talk directly to the immediate family in a
very nice way to let them know what happened and if an autopsy needs to
be done. Explain why an autopsy needs to be done and the family will
likely understand. Recognize that for the Vietnamese, we don’t believe
in opening the body to get tissues or organs, neither for autopsy nor
organ donation. We believe that we were born with everything and we will
die with everything. Very seldom is it that the family members will
agree with you to open the dead body, however if you explain the
necessity in a manner that is respectful, they will understand.
Recently, the Vietnamese who have come to the U.S. have learned about
the law here. It will depend on the family whether they agree with
autopsy or not. When talking about the Vietnamese community’s acceptance
of the practice of autopsy, limited is probably a better word to use
than prohibited.

Monk: Autopsy is not prohibited by Buddhist law.

Medical Examiner: We work under legal authority. At
some point it becomes our legal responsibility to do an autopsy. We will
always work with the family up to a certain point, and advise of other
options if we can forego an autopsy and still learn the cause of death
in another way. In a homicide situation, the purpose of the autopsy is
to benefit the entire community so the death can be explained. To do the
autopsy becomes a matter that transcends the interests of the family or
any one group. We are forced to perform the autopsy when there is a
homicide. There may be other options to autopsy in some instances,
however these alternatives may not be any more suitable as they present
some time delays. We always try to do things as quickly as possible so
we can return the body back to the family and avoid delays. The best
course of action, as we see it, is to try and let us do what we need to
do, and in that way we can avoid delays.

Expressing Condolences

CCM: Express your condolences in a normal way. Say that you are sorry to hear about the death and that you send your sympathies.

Time Constraints For The Community

CCM: Usually the Vietnamese choose a burial date
that matches well with the age of the family member who died. They get
advice from the monk who will say when to do the burial, the prayer or
the chanting on a certain day and at a certain time. That timeline is
very important, too.

Monk: As I understand it, sometimes families in the
Vietnamese community will have several religious sessions with family
surrounding the body, chanting and doing prayers. The Vietnamese will
have 49 days, or seven weeks, of mourning following a death.

Support For The Grieving

Medical Examiner: We work with social workers and
psychological support people. Will there be any need in the Vietnamese
community for professional grief counseling, or do you consider that the
community will take care of that or rely more on community support?

CCM: Usually, we rely on community support.

Facilitator: Again, it is important to assess the
situation individually. There may be a stigma to psychiatric and mental
health issues. When offering grief counseling, it is important to
normalize it. Let whomever you are talking to know that this counseling
is available in our system because so many people have a difficult time
in this period. Convey that these counselors are trained to help during
this time, and that we consider the need for help to be very normal.

Funeral Practices

CCM: When the body is ready to be put in the coffin,
the Buddhists and Catholics do things differently. The Buddhists do
chanting and use very special clothing and blankets to cover the body.
Whether to cremate or to bury a body is a personal family decision, not
dictated by religion.

Medical Examiner: Sometimes, if the death occurs by
natural causes we can release the body to a funeral home. Are there
certain funeral homes that are used?

CCM: With my experience, Bonney Watson is one, and
Columbia is another. They allow chanting and using incense. They will do
whatever they can for family members. They know Vietnamese families use
their funeral services a lot.

Monk: We use oil lamps, but not the incense.

CCM: We use oil lamps too. Each person burns incense also.

Religious Affiliations In The Vietnamese Community

CCM: If the family is Buddhist, I can assume that
the child within the family will be Buddhist also. Young people are seen
at the temple.

Monk: On Sundays, there is a program for kids only at the temple. Throughout the day, around 200 kids are there and are very active.

CCM: Also, the Vietnamese Catholic Church is very busy with lots of activities for children, too.

CCM: There are around eight to ten Vietnamese
Buddhist temples in Seattle. The two big ones are called Vietnam
Buddhist Temple and Co Lam Buddhist Temple.

Naming Conventions

CCM: If you don’t know the person well, you call
them Mr., Mrs. or Ms. and use their last name. Back home in Vietnam, we
call a person whom we don’t know well by their given name. In that case,
you would use the last, middle, then first name. Ninety percent of the
time you will see the middle names “Van” for a man, and “Thi” for a
woman. When we marry, we don’t change our last names. So, in a family
you will see different last names. But the children will carry the
father’s last name.

During a person’s last minutes, a monk may encourage him/her to leave the Earth happily so that they will go to a new world that is happy. Although there is no objection to autopsy, it is encouraged that the body be left alone 6-8 hours before an autopsy is performed. This is because, at death, a spirit still needs time to leave the body. The body is left like a piece of wood, but the spirit may still be lingering around. The chanting is very important for lifting the spirit to go, and to help make a way for the spirit to go. For thousands of years, it has been believed that some days are better than other days for burial. There is a formula written in the holy books. But now, everyday is just like every other day, as the Earth moves around the Sun. Ninety to 95 percent of Vietnamese Buddhists will believe that there are certain days and times that are better for burial which include considerations of ages of family members. Monks will respect this belief, but are moving away from this practice. Generally, a burial happens within one to seven days of a death.

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